自体股骨头植骨生物型人工全髋关节置换治疗髋关节发育不良的疗效

Femoral head autograft for acetabular reconstruction in cementless total hip arthroplasty for developmental hip dysplasia

背景:CroweⅡ、Ⅲ、Ⅳ型髋关节发育不良患者真臼发育差,且受股骨头蚀损影响,外侧壁常有缺损,因此大部分患者均需采用自体植骨、假臼重建。目的:观察生物型人工全髋关节置换治疗髋关节发育不良时采用自体股骨头植骨的临床效果。方法:选择2007-03/2009-11四川省骨科医院髋部创伤科收治的髋关节发育不良继发骨性关节炎患者15例15髋,单侧患者双下肢不等长为(2.7±0.8)cm,置换前Harris评分为(41.6±12.8)分。术中15髋采用标准全髋关节置换,同时采用自体股骨头植骨重建髋臼旋转中心。置换后随访摄骨盆正位和患髋侧位X射线平片评价髋臼和股骨假体位置、植骨块愈合情况以及双下肢长度。结果与结论:置换后切口均Ⅰ期愈合。患者均获随访,随访时间一两年,平均1年。置换后12个月X射线平片示植骨块均已愈合。末次随访时单侧患者双下肢不等长(0.8±0.3)cm,Harris评分为(89.3±6.5)分,与置换前相比,差异均有显著性意义(P<0.05)。X射线平片示髋臼和股骨假体无移位,未见植骨块有明显移位和吸收塌陷征象。提示髋关节发育不良继发骨性关节炎行全髋关节置换时采用自体股骨头植骨有利于恢复髋臼旋转中心,提供良好髋臼固定。

BACKGROUND：Patients with Crowe Ⅱ,Ⅲ,Ⅳ type of hip dysplasia have poorly developed true acetabulum and often present with lateral wall defects due to femoral head erosion,so most patients require autologous bone graft and artificial acetabular reconstruction.OBJECTIVE：To evaluate the clinical effect of bulk femoral head autograft for acetabular reconstruction in cementless total hip arthroplasty（THA） for developmental hip dysplasia（DDH）.METHODS：From March 2007 to November 2009,THA was performed for 15 patients（15 hips） with osteoarthritis secondary to DDH.The length difference was（2.7±0.8） cm between two lower limbs of the unilateral DDH patients.The Harris scores were（41.6±12.8） points preoperatively.The standard procedure of THA was performed in 15 patients（15 hips）,the structural femoral head autograft for restoring normal level of rotating center of the acetabulum in other patients.RESULTS AND CONCLUSION：The incision healed by first intention in all patients.The duration of follow-up ranged from 1 to 2years（average 1 year）.The X-ray films showed bony healing between the grafted bone and the ilium in all patients.At last follow-up,the length difference was（0.8±0.3） cm between two lower limbs and the Harris score was（89.3±6.5） points,showing statistically differences（P 0.05） when compared with preoperation.The X-ray films showed no signs of dislocation,absorption and collapse of the grafted bone.THA combined with structural femoral head autograft for patients with osteoarthritis secondary to DDH can obtain favorable results.This method can restore normal level of rotating center of the acetabulum,provide reliable acetabular fixation,and restore acetabular bone stock in patients with Crowe type Ⅱ and type Ⅲ DDH.